Community Mental Health Clients Research Articles

Occupational therapists views on GAS-light as an outcome measure in community adult mental health

PurposeThe paper aims to gain understanding of perceived benefits and barriers to GAS-light as an occupational therapy outcome measure in community adult mental health. The study explored occupational therapists’ views on the client-centred nature of GAS-light and whether it is an applicable outcome measure for group intervention. It also aimed to understand how occupational therapists use of GAS-light informed their practice and the wider multidisciplinary team perspective.Design/methodology/approachThe study used a phenomenological design. This comprising of a focus group of occupational therapists experienced in using the tool, followed by framework analysis. Focus group questions were derived from literature.FindingsThree main themes were identified to reflect experiences relating to the GAS-light tool as an outcome measure; value in process, occupational narrative and language and expertise.Practical implicationsThe paper is indicative of practical implications regarding the use of the GAS-light tool with community mental health clients and therapists, including the perceived value in the process, the language used by the therapist and level of expertise.Originality/valueThis paper fulfils an identified need to contribute towards an evidence base for occupational therapy and mental health.

Community Mental Health Care Delivery During the COVID-19 Pandemic: Practical Strategies for Improving Care for People with Serious Mental Illness.

The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors’ collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature.

Uptake of a preventive care consultation offered to clients of a community mental health service.

Preventive care to address client chronic disease risks is not frequently provided in community mental health services. Offering clients an additional preventive care consultation has been shown to increase client receipt of such care. The ability of this approach to have a beneficial impact at the population level is however dependent on its level of acceptability and uptake among clients. No studies have previously reported these outcomes when the additional consultation is universally offered to all clients of a community mental health service. To address this evidence gap, this descriptive study was undertaken to determine community mental health clients' (1) reported acceptability, in principle, of such a model of care, (2) of those who were offered the additional consultation, the level of uptake, and (3) clinical and socio-demographic characteristics associated with uptake. Participants were clients of one community mental health service in Australia. Data were collected in 2017 by telephone interviews and study records. Data from three distinct participant sub-groups are reported. In response to a hypothetical question, 79.3% of participants (n=157) agreed that an offer of an additional preventive care consultation would be acceptable (Aim 1). Of the participants who were offered such a consultation (n=264), 37.8% took up the offer (Aim 2); and no clinical or sociodemographic characteristics were significantly associated with uptake (Aim 3). Findings support the feasibility of this model of care. However, further research is needed to identify barriers to uptake, and effective strategies to enhance consultation uptake. Trial registration: ACTRN12616001519448.

Atypical and Severe Nonsuicidal Self-Injury as an Indicator of Severe Psychopathology: Findings From a Sample of High-Risk Community Mental Health Clients.

This study examined whether atypical/severe nonsuicidal self-injury (NSSI; e.g., foreign body ingestion, cutting necessitating sutures) serves as a marker of severe psychopathology among 467 adult community mental health clients (n = 33 with an atypical/severe NSSI history). Information regarding psychiatric risk indicators was extracted from participants' psychiatric records. Generalized linear models with negative binomial distribution and log link function, as well as chi-square tests, were used to address study aims. Clients with a lifetime atypical/severe NSSI history met criteria for a significantly greater number of psychiatric risk indicators than clients with a lifetime history of common NSSI only; however, these clients were not significantly more likely to report recent suicidal actions. Individuals with an atypical/severe NSSI history may demonstrate more severe psychopathology than those with a history of common NSSI only. Thus, it may be clinically useful to consider individuals with an atypical/severe NSSI history as a high-risk subgroup.

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACTKnowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.

Lifetime trauma and suicide attempts in older clients with severe mental illness

ABSTRACTResearch examining links between lifetime trauma and suicide attempts in older clients with severe mental illness (SMI) is scarce. We examined associations among six common forms of lifetime trauma and lifetime suicide attempts while controlling for other known correlates of suicide attempts including gender, psychiatric symptoms, thoughts of self-harm/suicide, and lifetime self-injury in 174 community mental health clients with severe mental illness who were 50 years of age or older. Almost all clients reported at least one traumatic event with a mean of twelve, more than half had attempted suicide at least once, and about one-third had made multiple suicide attempts. Regression revealed that four factors were significantly associated with lifetime suicide attempts: lifetime self-injurious behaviors, lifetime physical abuse, lifetime frequency of having witnessed severe violence, and lifetime homelessness. Lifetime self-injury accounted for the most variance in suicide attempts, but having been physically abused accounted for the most variance in suicide attempts among the six trauma items. Lifetime trauma should be carefully screened in older clients with severe mental illness given preliminary evidence that it might be linked to suicide risk. Limitations of this study include the cross-sectional design.

Measuring Quality of Care in Community Mental Health: Validation of Concordant Clinician and Client Quality-of-Care Scales.

Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.

An Exploratory Study of the Experiences of Adult Multiracial Community Mental Health Clients in a Metro Vancouver City

In the 2006 census, 458, 240 Canadians reported belonging to more than one population group, a 25% increase from 2001. Although little Canadian research has explored multiraciality, American and British research demonstrates there are differences in the mental health and substance use rates of multiracial individuals when compared to monoracial groups.Ten multiracial community mental health clients were interviewed to explore how multiraciality affected their wellbeing. Participants discussed racism, belonging, spirituality, identity, strengths and good care. Suggestions for improving mental health services to multiracial individuals are discussed. Au recensement de 2006, 458, 240 Canadiens ont declare appartenir a plus d’un groupe de population soit une augmentation de 25% par rapport a 2001. Bien que peu de recherche a explore la multiracialite, les recherche Americains et Britanniques demontrent qu’il y a une difference dans la sante mentale et le taux d’utilisation de la substance des personnes multiracials par rapport aux groupes monoracial. Dix clients communautaire sante mentale ont ete interviewes pour explorer comment la multiracialite a affecte leur bienetre. Les participants ont discute le racisme, l’appartenance, la spiritualite, l’identite, les forces et les bons soins. Il conclut avec suggestions pour ameliorer les services de sante mentale chez les personnes multiracials.

Evaluating the effectiveness of a healthy lifestyle clinician in addressing the chronic disease risk behaviours of community mental health clients: study protocol for a randomised controlled trial

BackgroundPeople with a mental illness experience a greater morbidity and mortality from chronic diseases relative to the general population. A higher prevalence of modifiable health risk behaviours such as smoking, poor nutrition, physical inactivity and harmful alcohol consumption contribute substantially to this disparity. Despite clinical practice guidelines recommending that mental health services routinely provide care to address these risk behaviours, the provision of such care is consistently reported to be low internationally and in Australia. This protocol describes a randomised controlled trial that aims to assess the effectiveness of allocating a clinician within a community mental health service to the specific role of providing assessment, advice and referral for clients’ chronic disease risk behaviours.Methods/designApproximately 540 clients of one community mental health service will be randomised to receive either usual care for chronic disease risks provided in routine consultations or usual care plus an additional face-to-face consultation and follow-up telephone call with a ‘healthy lifestyle clinician’. The clinician will assess clients’ chronic disease risk behaviours, provide advice to change behaviours, and refer at-risk clients to free telephone coaching services (New South Wales (NSW) Quitline and NSW Get Healthy Information and Coaching Service) for specialist behaviour change care. The primary outcomes, regarding referral to and client uptake of the telephone services, will be obtained from the respective services. Telephone interviews of clients at baseline and at 1 and 6 months post baseline follow-ups will assess secondary outcomes: receipt of any assessment, advice and referral from the mental health service; satisfaction with the receipt of such care; satisfaction with the receipt of any care provided by the telephone services; interest and confidence in and perceived importance of changing risk behaviours; and risk behaviour status.DiscussionThis study will add to the limited literature regarding effective strategies to address chronic disease prevention among the higher risk population of community mental health clients. The results will inform the development of future policies and service delivery initiatives to address the high prevalence of chronic disease risk behaviours among people with a mental illness.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616001519448. Registered on 3 November 2016.

Post-traumatic Stress and Trauma-Related Subjective Distress: Comparisons Among Hispanics, African-Americans, and Whites with Severe Mental Illness

We tested the hypothesis with a sample of community mental health clients (N = 132) that Hispanic clients would report significantly greater post-traumatic stress symptoms than African-American or white clients when controlling for gender, psychiatric symptoms of SMI, and subjective distress from six of the most commonly reported trauma in the SMI literature. Results supported our main hypothesis: being self-identified as Hispanic was significantly associated with greater post-traumatic stress symptoms. Subjective distress from having been sexually abused along with being "Hispanic" were the only two significant variables left in the equation. Limitations of this study include its modest sample size.

Subjective distress from trauma in older clients with severe mental illness

ABSTRACTThere is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.

Trauma and health risk behaviors in people with severe mental illness

ABSTRACTThe current study tests the association between a composite measure of unsafe sex and sharing syringes for drug use with six of the more common lifetime traumatic/stressful events in 421 community mental health clients with severe mental illness (SMI) while controlling for psychiatric symptoms and related problems. A small but significant proportion of respondents said they had injected drugs with a shared needle in their lifetime (30, 7.2%), and a much larger proportion of respondents had engaged in unprotected sex (165, 39.2%). Unprotected sex and needle sharing were significantly correlated (Spearman’s rho = .20, p < .01). Frequency of lifetime traumatic events that occurred at least once was reported by one third to three quarters of clients depending on type of trauma. Regression analysis revealed that substance abuse and lifetime homelessness were significantly correlated with health risk behaviors. Practitioners need to be continuously vigilant to comorbid substance use and the housing needs of people with SMI. Limitations of the study include its cross-sectional design.

Delivering cognitive processing therapy in a community health setting: The influence of Latino culture and community violence on posttraumatic cognitions.

Despite the applicability of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) to addressing sequelae of a range of traumatic events, few studies have evaluated whether the treatment itself is applicable across diverse populations. The present study examined differences and similarities among non-Latino, Latino Spanish-speaking, and Latino English-speaking clients in rigid beliefs-or "stuck points"-associated with PTSD symptoms in a sample of community mental health clients. We utilized the procedures of content analysis to analyze stuck point logs and impact statements of 29 participants enrolled in a larger implementation trial for CPT. Findings indicated that the content of stuck points was similar across Latino and non-Latino clients, although fewer total stuck points were identified for Latino clients compared to non-Latino clients. Given that identification of stuck points is central to implementing CPT, difficulty identifying stuck points could pose significant challenges for implementing CPT among Latino clients and warrants further examination. Thematic analysis of impact statements revealed the importance of family, religion, and the urban context (e.g., poverty, violence exposure) in understanding how clients organize beliefs and emotions associated with trauma. Clinical recommendations for implementing CPT in community settings and the identification of stuck points are provided.

Interrelationships Among Physical Health, Health-Related, and Psychosocial Characteristics of Persons Receiving Integrated Care in Community Mental Health Settings

ABSTRACTIntegrated primary and behavioral health care (PBHC) programs in community mental health (CMH) settings seek to address the health disparities and excess mortality of persons with serious mental illness (SMI) and comorbid medical disorders. The current cross-sectional, descriptive study utilized an integrated health data set to examine interrelationships among physical health, health-related, and psychosocial characteristics of 125 clients receiving integrated PBHC services in a CMH setting. Using baseline data collected by nurse care managers, researchers sought to develop a comprehensive, person-centered profile of adults in CMH agencies. Results showed that participants reported fair overall health, with mean scores on four of eight health indicators in the at-risk range. Disparities on some measures emerged for women, African Americans, and clients with a family history of cardiometabolic disorders. Participants reported moderate levels of functioning and psychological distress and moderately high levels of social connectedness. Approximately 27% of the variance in overall health was explained by five predictors in the model. Blood glucose levels and daily functioning were the strongest predictors of health status. Results are consistent with research on comorbidity that emphasizes the multidimensionality of health. Future social work research should employ multivariate approaches to identify disparities and clarify treatment needs of diverse CMH clients.

A Cognitive Behavioural Intervention for Case Managed Clients.

This paper outlines a cognitive behavioural therapy (CBT) based psychosocial intervention for case managed clients in a community mental health setting. The aim of the study was to design a CBT based psycho-educational program which addressed stress management and supported self-management skills for case managed clients with chronic and serious mental illness. It was anticipated that the CBT intervention group would have improved post study levels of functioning, and decreased levels of distress, as compared to the control group. Twenty-four clients volunteered for the study, eight females and 16 males. They ranged in ages from 20 to 69 years, with an average age of 43.5 years. There was no specific diagnostic group targeted. Outcome measures used were the Health of the Nation Outcomes Scale and the Mental Health Inventory. The CBT intervention was run for 2 hours a week over 8 weeks using a group format. There was an improvement in behavioural problems, indicating an improvement in functioning and a decrease in anxiety levels. It was concluded that CBT based psycho education programs can improve outcomes for community mental health clients.

Sudden losses and negative appraisal in people with severe mental illness.

Research on the impact of sudden or unexpected losses in people with severe mental illness is scarce. The purpose of our study was to examine the relationship between subjective distress from sudden losses in people with severe mental illness and posttraumatic stress symptoms while controlling for gender, psychiatric symptoms, and negative appraisals. As part of routine care, treatment personnel collected data from 371 community mental health clients diagnosed with a severe mental illness. Hierarchical linear regression revealed that negative appraisals of the self and the world correlated significantly with posttraumatic stress symptoms, and distress from losses accounted for the greatest amount of variance in posttraumatic stress symptoms of the 6 traumas tested. When examined by diagnostic group, only those with schizophrenia spectrum disorder showed a significant association between distress from sudden losses and posttraumatic stress symptoms. Relative to other factors including symptoms of severe mental illness, distress from sudden losses in people with severe mental illness appears to be strongly associated with posttraumatic stress symptoms.

Lifetime Trauma and Suicide Attempts in People with Severe Mental Illness

We examined associations among six forms of common lifetime traumatic/adverse events and lifetime suicide attempts while controlling for gender, psychiatric symptoms, self-injury, and substance use in 371 community mental health clients with severe mental illness. Most clients (88.1%) reported at least one traumatic event, and more than half had attempted suicide at least once. Regression revealed that three factors were significantly associated with lifetime suicide attempts: lifetime self-injurious behaviors, lifetime physical abuse, and alcohol use. Having been physically abused appears to be uniquely associated with lifetime suicide attempts when other key risk factors are controlled. Limitations include the cross-sectional design.

A group based smoking cessation pilot programme for community mental health clients in Sydney

Introduction: This article describes the process and evaluation of a smoking cessation support programme for mental health clients in Sydney.Aim: The objective of the study was to assess a group-based smoking cessation support model for community mental health clients.Methods: Two community mental health services participated; 29 clients received free NRT products and weekly education for 12 weeks on: effects of smoking, nicotine dependence, NRT use, withdrawal process and the benefits of quitting. Evaluation included face-to-face interviews, telephone or postal survey using a semi-structured questionnaire.Results: The baseline (n = 29) and follow-up (n = 14) surveys showed reduction in the number of cigarettes (30 to 21) smoked a day (55% vs. 36%). At one month 47% (n = 19) were confident about stopping smoking permanently whereas 19% (n = 14) reported the same after six months. Participants reported concerns of health effects, illness, physical symptoms (77% n = 27) and financial cost (93% n = 27) were the motivating factors in quitting. None of the findings was statistically significant.Conclusions: Community based interventions to address the rate of smoking in this group is needed. Financial and health benefits can be used as motivating factors, and integration of smoking cessation assistance in treatment and rehabilitation of mental health consumers would be useful.

Lifetime Trauma, Subjective Distress, Substance Use, and PTSD Symptoms in People with Severe Mental Illness: Comparisons Among Four Diagnostic Groups

The current study examines correlations among trauma, high risk behaviors, subjective distress from both trauma and high risk behaviors, and substance use in community mental health clients diagnosed with a severe mental illness, and tests the following key hypothesis: clients with major mood disorders (major depression, bipolar I) will show higher rates of posttraumatic stress disorder (PTSD) symptoms than clients with either schizophrenia or schizoaffective disorder when trauma, high risk behaviors, subjective distress, substance use and gender are controlled. Linear regression demonstrated that only major depression and bipolar disorder varied significantly with PTSD symptoms when controlling for other key factors.

Substance Use Motives in People With Severe Mental Illness: Comparisons Among Four Diagnostic Groups

Research has consistently shown that alcohol consumption motivated by a desire to alleviate negative emotional states predicts alcohol use and relapse among clients with cooccurring psychiatric disorders. However, studies examining the role of drinking motives in people with severe mental illness are few. This study of 283 community mental health clients (43.8% men, 55.1% women), assigned a primary Axis I diagnosis of schizophrenia (28.3%), schizoaffective (23.3%), major depression (31.1%), or bipolar I disorder (17.3%), tested the hypothesis that clients with a diagnosis of mood disorder would report greater substance use, would indicate more problems associated with substance use, and would be more likely to use substances to cope with negative emotions than would clients with schizophrenia. In addition, coping motives would account for more variance in substance use and related problems than would convivial drinking when controlling for age, gender, and Axis I diagnosis. Results largely supported these hypotheses with some exceptions. Implications for theory, research, and practice with comorbid clients are suggested.